ESPRAS Survey on Breast Reconstruction in Europe.

Background:  The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access.

Materials And Methods:  A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country.

Management of inguinal lymphadenopathy: immediate sartorius transposition and reconstruction of recurrence with pedicled ALT flap.

Inguinal lymphadenectomy is associated with considerable morbidity, and several attempts have been made to minimize the morbidity by well-vascularized flaps of adequate bulk to obliterate the dead space and promote wound healing. In the case of recurrence, the overlying skin is usually involved and the reconstructive surgeon is confronted with exposed femoral vessels and complex groin defects. We report a series of 40 patients that underwent inguinal lymphadenectomy and immediate sartorius transposition for skin malignancies, and 4 patients with recurrence that was treated with radical surgical excision and pedicled anterolateral thigh flap (ATL).

Recipient vessel exposure in the axilla during microvascular breast reconstruction.

Over the years, the favored recipient vessels for microvascular breast reconstruction have changed from the thoracodorsal to the internal mammary vessels, mainly due to the deep position and poor exposure of the vessels in the axilla and all the technical difficulties this reflects. We used the simple maneuver of arm adduction during microvascular anastomoses in the axilla and compared it with the conventional method of abducted arm regarding the exposure of the vessels, the position of the operator and the assistant, and the operative time. We found that this innovation considerably improved the exposure of the vessels and the operator's position, facilitating easier and faster anastomoses.

Salvage of finger length in septicemic necrosis using 3 free flaps from a single anterolateral thigh donor site.

Severe septicemic necrosis can result in extremely debilitating morbidity for patients, often resulting in 4-limb amputation. Further operative procedures to improve both function and cosmesis can be fraught with complexity and complications. The ideal aim in such patients would be to maintain sufficient length and provide soft tissue cover in a single 1-step procedure.

A method for protecting the anastomosis in deep inferior epigastric artery perforator flap breast reconstruction.

In cases of microvascular breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps, many authors often express concern about possible trauma to the microanastomosis from the suction drain routinely placed in the wound at the end of the case. The senior author has devised and practiced for many years a novel technique to protect the anastomosis from this potential trauma in breast reconstructions. This technique involves harvesting a "sleeve" of scarpa's fascia in the direction of the planned orientation and inset of the flap pedicle.

The relationship between protease/anti-protease profile, angiogenesis and re-epithelialisation in acute burn wounds.

In the management of partial thickness burns, it is difficult to balance between conservative management and surgical intervention. Our hypothesis was that a triangular relationship exists between protease/anti-protease profile at the burn wound surface, angiogenesis and re-epithelialisation. By manipulation of the biochemical profile at the wound level, we determined to affect the nature and extent of angiogenesis and resulting re-epithelialisation.

A large encapsulated seroma presenting as a mass 5 years post paraumbilical hernia repair.

Abdominoplasty is a procedure commonly performed by the modern reconstructive plastic surgeon, but despite its apparent routine nature complications are well documented in the literature and should be respected by even the most experienced plastic surgeon. Seroma is one of the most common complications known, however, most seromas usually occur within a few months following the primary procedure, are easily identifiable clinically as seroma and respond to simple aspiration, or resolve without any further intervention. We report the case of a 55-year-old female who presented with an unusual large abdominal mass 5 years following paraumbilical hernia repair and which was initially presumed to be an ovarian tumour.

Innovative techniques: a novel technique for intraoperative estimation of breast implant size in aesthetic and reconstructive breast surgery.

The estimation of breast implant size in both aesthetic and reconstructive surgery often is a matter of clinical and intraoperative trial and error, with subsequent differences in the resulting postoperative outcomes. Numerous techniques for preoperative estimation of implant size are in current use. However, although such techniques are inexpensive, they often are inaccurate and prone to error on the part of both the surgeon and the patient.