{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:46:24Z","timestamp":1787496384272,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Second victim syndrome (SVS) is when a health care provider involved in a patient complication is traumatized by the event, manifesting as symptoms of anxiety, depression, and shame. We investigated microvascular surgeons' emotional responses to free flap failure and their emotional support systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010question survey of microvascular surgeons. Questions focused on participant demographics and practice dynamics, emotional responses to free flap failure, and emotional support systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety\u2010three surgeons completed the survey and reported emotional responses to free flap failure. Survey response rate was 47.6%. Most (83.9%) practiced in an academic setting. Over half of surgeons reported anxiety (74%), guilt (70%), sadness (68%), shame or embarrassment (63%) and doubt (51%) following flap failure. Females were statistically more likely to report sadness (82% vs. 58.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018) and doubt their surgical acumen (61.8% vs. 34%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) compared to men. Women rated therapists (3.88 vs. 2.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and online forums (6.18 vs. 1.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.011) to be better support systems than those reported by men. Surgeons who had a recent free flap failure in the last 6\u2009months expressed a desire to decrease free flap volume compared to those who had a free flap failure &gt;\u20096\u2009months (34% vs. 14%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Flap failure results in SVS for microvascular surgeons of all ages, gender, and geographic distributions. Interventions during the first 6\u2009months after a free flap failure may be most beneficial to microsurgeons going through an emotionally challenging time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70070","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:05:32Z","timestamp":1756292732000},"page":"750-756","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Microvascular Surgeons: The Second Victim With Free Flap Failure"],"prefix":"10.1002","volume":"136","author":[{"given":"Matthew B.","family":"Studer","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University School of Medicine  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina Elmudesi","family":"del Rio","sequence":"additional","affiliation":[{"name":"Universidad Iberoamericana (UNIBE)  Santo Domingo Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca E.","family":"Rdesinski","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0250-8636","authenticated-orcid":false,"given":"Mark K.","family":"Wax","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-1421","authenticated-orcid":false,"given":"Sara","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7237.726"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2016.12.039"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215121000797"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-029923"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192416869"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20076"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1729639"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1759563"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1989.01860320064020"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2015.08.011"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.09.045"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.11.018"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.5640"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199109000-00004"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1000192"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.09.025"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.12058"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.07.024"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1754073914544408"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000129"},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"l1233","DOI":"10.1136\/bmj.l1233","article-title":"Abandon the Term \u201cSecond Victim","volume":"364","author":"Clarkson M. 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