The benefits of dual-consultant operating in complex breast reconstruction: A retrospective cohort comparison study.

Background: Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities.

Methods: A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020.

Salvage of a TRAM breast reconstruction flap using the retrograde internal mammary artery system.

Background: Free tissue transfer provides an optimal means for breast reconstruction in creating an aesthetically natural appearance that is durable over time. The choice of donor vessels vary from surgeon to surgeon, but the internal mammary axis is one of the most popular choices together with the thoracodorsal vessels.

Aims And Results: We present the case of a salvaged free transverse rectus abdominis myocutaneous breast reconstruction in which end-to-end antegrade anastomosis to the internal mammary artery (IMA) was not possible due to frail vessel walls, but retrograde anastomosis to the IMA and antegrade anastomosis of internal mammary vessel resulted in a perfused and viable flap.

Complications of the 'Enhanced Recovery after Surgery Programme' following pedicled vertical rectus abdominis myocutaneous flap in perineum reconstruction.

The enhanced recovery programme, pioneered in the colorectal surgical setting, aims to reduce the length of inpatient stay following a procedure and was started in our trust in 2006. We present the case of a patient who underwent perineal reconstruction with a pedicled vertical rectus abdominis myocutaneous (VRAM) who subsequently developed bladder outflow obstruction compromising flap viability. As a result of our experience we are in the process of producing new guidelines that advocate patients undergoing a VRAM flap for perineal reconstruction should be exempt from aspects of the enhanced recovery programme, in particular early removal of the catheter should be avoided.